ObjectiveTo study the expression of HOX A9 mRNA and its clinicopathological significance in the benign and malignant lesions of pancreas. MethodsIn situ hybridization for HOX A9 mRNA was used on routine paraffinembedded sections. ResultsThe positive rate and scoring mean of HOX A9 mRNA expression was significanfly lower in pancreatic carcinoma (49%, 3.3±2.1) than that in chronic pancreatitis (95%, 5.4±0.8) and pericancerous tissues (80%, 4.6±1.2), the negative case of HOX A9 mRNA in chronic pancreatitis and pericancerous tissues showed middle or severelyatypical hyperplasis of the ductal epitheli. The positive rate and scoring mean of HOX A9 mRNA expression was significantly higher in the cases of welldifferentiation (63%, 4.0±2.2) or without metastasis (64%, 4.1±2.2) than that in the ones of poorlydifferentiation (32%, 2.6±2.3) or with metastasis (32%, 2.7±2.2). ConclusionThe expression of HOX A9 mRNA might be related the carcinogenesis, progress, biological behaviors, and prognosis of pancreatic carcinoma. The assay of HOX A9 mRNA expression in the benign lesions of pancreas might have important clinical values in the prevention and earlystage finding of the pancreatic carcinoma.
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
In February 2020, the American College of Gastroenterology (ACG) published the latest guideline on chronic pancreatitis, and put forward practical recommendations on the etiology, natural history, diagnosis, treatment, prognosis and follow-up of chronic pancreatitis. This paper aims to provide references for the diagnosis and treatment of chronic pancreatitis in China by interpreting the main content of the guideline and comparing it with related guidelines or consensuses domestically and abroad.
Objective To explore the feasibility and safety of Frey operation under laparoscopy in the treatment of chronic pancreatitis. Methods The clinical data of chronic pancreatitis patients who underwent laparoscopic Frey procedure in Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University from 2021-2023 were retrospectively analyzed. Results Eleven patients with chronic pancreatitis complicated with pancreatic duct stones were included in the study, 7 of whom had a history of diabetes and (or ) impaired glucose tolerance, suggesting that pancreatic endocrine function was impaired. The median diameter of the main pancreatic duct measured by imaging method was 8 mm (4–20mm). The median operative time was 188 min (120–368 minutes), and the total intraoperative bleeding volume was 50 mL (20–100 mL). Postoperative pancreatic fistula did not occur, one case of postoperative abdominal fluid accumulation and hypoproteinemia improved after symptomatic supportive treatment such as anti infection, acid and enzyme inhibition, and nutritional rehydration. Postoperative bleeding occurred in 3 cases, including 1 case of intestinal anastomotic bleeding, which was sutured again under emergency laparoscopic intestinal anastomosis to stop bleeding. The other two cases improved after conservative management such as blood transfusion, plasma, vitamin K, acid inhibition, enzyme inhibition and hemostatic drugs. The median postoperative hospitalization time was 7 days (4–18 days), and no patient mortality happened within 90 days after surgery. Conclusion Laparoscopic Frey operation is feasible and a relatively safe and effective method for the treatment of chronic pancreatitis.
ObjectiveTo review the current clinical application of Beger procedure and Frey procedure for benign disease or low-grade malignant potential lesion of pancreas. MethodsRelevant literatures about current advance of clinical application of Beger procedure and Frey procedure published recently of domestic and abroad were collected and reviewed. ResultsWith the concept of organ-preserving operations was adopted in recent years, Beger procedure and Frey procedure were applied generally. Beger procedure and Frey procedure were associated with tolerable perioperative risk, postoperative complications, and good outcomes in the aspects of preservation of function and curability in these lesions compared to conventional pancreatectomy, with preservation of the physiological food passage, thus patients gained weight faster, had less pain, and demonstrated better exocrine and endocrine pancreatic function postoperatively and an improvement in the quality of life. Both procedures had reached an international position as a standard operation for the treatment of benign disease or low-grade malignant potential lesion of pancreas. But after long-term following-up early advantages were no longer present. ConclusionsBeger procedure and Frey procedure are safe and effective in providing good outcomes in the aspects of preservation of function and curability in benign disease or low-grade malignant potential lesion of pancreas. Organ-preserving pancreatectomy could become a new organ-preserving standard operation.
ObjectiveTo investigate the differential diagnosis of chronic pancreatitis with mass of pancreatic head and pancreatic carcinoma, and choose the effective treatment of chronic pancreatitis with mass of pancreatic head. MethodsEighty cases of chronic pancreatitis with mass of pancreatic head from January 2008 to January 2014 in this hospital were retrospectively analyzed.The preoperative blood tumor markers, hepatobiliary and pancreatic color Doppler ultrasound, CT strengthen, MRI, MRCP, or other imaging studies were tested for all the patients. ResultsThere were 4 cases of long-term drinking or excessive drinking history in 8 cases of chronic pancreatitis with mass of pancreatic head.The past medical history included 5 patients with acute pancreatitis, 3 patients with chronic cholecystitis, 2 patients with cholecystolithiasis.Six patients had varying degree of jaundice and 5 patients had left upper abdominal pain.There were 4 patients with high blood sugar, 6 patients with serum hyperbilirubin, 5 patients with elevated CA19-9 and 2 patients with elevated CEA by serum assay.The imaging revealed that a mass was in the head of the pancreas.The standard pancreaticoduodenectomy was performed in 6 cases, duodenum-preserving pancreatic head resection was performed in 2 cases.These 8 patients underwent the intraoperative fine needle aspiration cytological examination revealed the changes of chronic pancreatitis by postoperative pathology.The levels of CA19-9 and CEA on 1 week after operation were reduced to normal levels in patients with elevated CA19-9 and CEA alone or together.There was no case of serious complications such as postoperative pancreatic leakage and bile leakage.The intermittent vomiting appeared in 3 months after duodenum-preserving pancreatic head resection, the upper gastrointestinal radiography showed the stenosis of duodenum, the contrac-tures of the duodenum, especial the descending duodenum, was found through reoperation, the symptom was relief after gastrojejunal anastomosis.The recurrence was not seen in all these 8 patients with follow-up of 1-6 years. ConclusionsThe jaundice and abdominal for the patients with pancreatic head mass of chronic pancreatitis and pancreatic cancer pain are the main symptoms, but their characteristics are different, the former is minor, volatility, and intermittent; the latter is sustained and progressively aggravated.Understanding of past medical history for the identification of both is some significances.CA19-9 and CEA as the identification of the pancreatic head mass in chronic pancreatitis and pancreatic cancer is not meaningful.Patients with chronic pancreatitis of pancreatic mass are finished by multi-needle biopsy for pancreatic head mass, duodenum-preserving pancreatic head resection is preferred.Patients with invasive pancreatic mass and peripheral vascular adhesion must undergo standard pancreaticoduodenectomy.
Objective To compare the surgical outcome of surgical treatment for chronic pancreatic head mass pancreatitis combined with pancreatic duct stones. Methods Clinical data of 19 patients diagnosed as chronic pancreatic head mass pancreatitis combined with pancreatic duct stones by pathology in our hospital were analyzed retrospectively and patients were divided into Beger group (n=9) and Frey group (n=10) according to operation type. Results The duration of operation, blood loss, morbidity, ratio of postoperative pancreatic fistula of grade B, ratio of abdominal cavity infection, ratio of gastric emptying dysfunction, total length of hospital stay, and total hospitalization cost in Frey group were less or lower than those in Beger group significantly (P ＜0.05). None of death or pancreatic fistula of grade C happened in both 2 groups, and abdominal pain and jaundice were subsided in all patients. There were 18 patients (94.7%) were followed up for (8.6±2.5) years ( 5-12 years), and just 1 patient of Frey group was not available for followup. The ratios of 5-year pain subsided of 2 groups were both 7/9, there was no significant difference between the 2 groups (P>0.05). During the follow-up period, there was no dead, relapsed, cancerate or reoperation, but 2 patients suffered from diabetes (1 patient of Frey group and 1 patient of Beger group), 2 patients suffered from steatorrhea (1 patient of Frey group and 1 patient of Beger group), and there was no significant difference between the 2 groups in the ratios of diabetes and steatorrhea (P>0.05). Conclusion The effect is equal for Frey surgery and Beger surgery in treatment of chronic pancreatic head mass pancreatitis combined with pancreatic duct stones, but recover of patient who receives Frey surgery is better than that of Beger surgery.
To evaluate the present status of treatment of chronic pancreatitis, 116 consecutive patients with chronic pancreatitis during the last decade (1986～1996) have been surveyed retrospectively. The clinical date has been analized statisticaly. Etiology: biliogenic 56 cases (48.3%), alcoholic 17 (14.6%), idiopathic 34 (29.3%) and other 9 cases (7.8%). Better result was achieved in surgical treatment group (81 cases) than in conservative group (35 cases), pain free: 65.5% vs 33.3%. The accumulated five-year survival rate was 56.3%, 92.2% and 78.1% in alcoholic, billiogenic and idiopathic type of chronic pancreatitis respectively. Morbidity and mortality of diarrhea and diabetes mellitus increased at followup. The authors conclude that the chronic pancreatitis patients associated with obstruction of biliopancreatic duct should undergo operation early and will ameliorate abdominal pain.
ObjectiveTo summarize of clinical application and progress of duodenum-preserving pancreatic head resection (DPPHR).MethodThe relevant literatures published recently at domestic and abroad about the clinical application and progress of DPPHR were collected and reviewed.ResultsFor the benign lesions, low-grade malignancies and borderline tumors of the head of pancreas, the DPPHR could achieve the same expected therapeutic effect as the classical pancreatoduodenectomy. The DPPHR could reserve the continuity of stomach and duodenum while resecting lesions and improve the symptoms of patients, reduce the reconstruction of digestive tract and the resection of pancreas and surrounding tissues as much as possible, and retain the pancreas-intestinal axis, which was more in line with the physiology of human beings.ConclusionsAt present, DPPHR is worthy of further development and promotion in department of pancreas surgery, but current studies only focus on occurrence of short-term complications after operation. Because patients with benign diseases of pancreatic head have better prognosis and longer survival time after operation, we should pay attention to the long-term complications such as diarrhea, anemia and reflux cholangitis. More clinical studies need in future to be demonstrated superiority of DPPHR in clinical efficacy and to evaluate occurrence of long-term complications and their impact on quality of life of patients with DPPHR by comprehensive analysis of multiple evaluation indicators.